Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OSMOLALITY,SERUM

Facility

$94.00

Service Code	HCPCS 83930
Hospital Charge Code	38477020
Hospital Revenue Code	301
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$14.10
Rate for Payer: Qualcare PPO/HMO/WC	$14.10

OSMOLALITY,SERUM

Facility

$94.00

Service Code	HCPCS 83930
Hospital Charge Code	38477020
Hospital Revenue Code	301
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$17.98
Rate for Payer: Aetna Medicare Advantage	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.86
Rate for Payer: Cigna Commercial	$47.00
Rate for Payer: Cigna Medicare Advantage	$6.61
Rate for Payer: Clover Medicare Advantage	$6.28
Rate for Payer: EmblemHealth Commercial	$19.83
Rate for Payer: Humana Medicare Advantage	$6.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.61
Rate for Payer: Wellcare Medicare Advantage	$6.61
Rate for Payer: Wellpoint Medicaid Managed Care	$2.49

OSMOLALITY (STOOL)

Facility

$390.00

Service Code	HCPCS 84999
Hospital Charge Code	3009883
Hospital Revenue Code	301
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

OSMOLALITY (STOOL)

Facility

$390.00

Service Code	HCPCS 84999
Hospital Charge Code	3009883
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

OSMOLALITY, URINE

Facility

$156.20

Service Code	HCPCS 83935
Hospital Charge Code	3004918
Hospital Revenue Code	301
Min. Negotiated Rate	$23.43
Max. Negotiated Rate	$23.43
Rate for Payer: Qualcare PPO/HMO/WC	$23.43

OSMOLALITY, URINE

Facility

$156.20

Service Code	HCPCS 83935
Hospital Charge Code	3004918
Hospital Revenue Code	301
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$18.55
Rate for Payer: Aetna Medicare Advantage	$22.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.62
Rate for Payer: Cigna Commercial	$78.10
Rate for Payer: Cigna Medicare Advantage	$6.82
Rate for Payer: Clover Medicare Advantage	$6.48
Rate for Payer: EmblemHealth Commercial	$20.46
Rate for Payer: Humana Medicare Advantage	$7.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.43
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.82
Rate for Payer: Wellcare Medicare Advantage	$6.82
Rate for Payer: Wellpoint Medicaid Managed Care	$4.14

OSMOLALITY,URINE

Facility

$102.00

Service Code	HCPCS 83935
Hospital Charge Code	38477023
Hospital Revenue Code	301
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$15.30
Rate for Payer: Qualcare PPO/HMO/WC	$15.30

OSMOLALITY,URINE

Facility

$102.00

Service Code	HCPCS 83935
Hospital Charge Code	38477023
Hospital Revenue Code	301
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$18.55
Rate for Payer: Aetna Medicare Advantage	$22.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.62
Rate for Payer: Cigna Commercial	$51.00
Rate for Payer: Cigna Medicare Advantage	$6.82
Rate for Payer: Clover Medicare Advantage	$6.48
Rate for Payer: EmblemHealth Commercial	$20.46
Rate for Payer: Humana Medicare Advantage	$7.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.82
Rate for Payer: Wellcare Medicare Advantage	$6.82
Rate for Payer: Wellpoint Medicaid Managed Care	$2.70

OSMOLITE HIGH NITROGEN

Facility

$23.00

Hospital Charge Code	60634855
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

OSMOLITE HIGH NITROGEN

Facility

$23.00

Hospital Charge Code	60634855
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

OSMOTIC FRAGILITY RBC

Facility

$187.25

Service Code	HCPCS 85557
Hospital Charge Code	3009987
Hospital Revenue Code	305
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.34
Rate for Payer: Aetna Medicare Advantage	$43.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.23
Rate for Payer: Cigna Commercial	$93.62
Rate for Payer: Cigna Medicare Advantage	$13.36
Rate for Payer: Clover Medicare Advantage	$12.69
Rate for Payer: EmblemHealth Commercial	$40.08
Rate for Payer: Humana Medicare Advantage	$13.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.36
Rate for Payer: Wellcare Medicare Advantage	$13.36
Rate for Payer: Wellpoint Medicaid Managed Care	$4.96

OSMOTIC FRAGILITY RBC

Facility

$187.25

Service Code	HCPCS 85557
Hospital Charge Code	3009987
Hospital Revenue Code	305
Min. Negotiated Rate	$28.09
Max. Negotiated Rate	$28.09
Rate for Payer: Qualcare PPO/HMO/WC	$28.09

OSRAM MERCURY BURNER

Facility

$780.00

Hospital Charge Code	270665507
Hospital Revenue Code	270
Min. Negotiated Rate	$18.80
Max. Negotiated Rate	$390.00
Rate for Payer: Aetna Commercial	$296.40
Rate for Payer: Aetna Medicare Advantage	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.90
Rate for Payer: Cigna Commercial	$390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.00
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$18.80
Rate for Payer: Wellpoint Medicaid Managed Care	$20.67

OSRAM MERCURY BURNER

Facility

$780.00

Hospital Charge Code	270665507
Hospital Revenue Code	270
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$117.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.00

OSS 1.5CC

Facility

$4,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270703615
Hospital Revenue Code	278
Min. Negotiated Rate	$105.44
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,662.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Community & State	$105.44
Rate for Payer: Wellpoint Medicaid Managed Care	$115.94

OSS 1.5CC

Facility

$4,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270703615
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

OSS 3CM RESURFACING KIT

Facility

$65,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270681527
Hospital Revenue Code	278
Min. Negotiated Rate	$9,832.50
Max. Negotiated Rate	$15,863.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,863.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,421.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,832.50

OSS 3CM RESURFACING KIT

Facility

$65,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270681527
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.76
Max. Negotiated Rate	$32,775.00
Rate for Payer: Aetna Commercial	$24,909.00
Rate for Payer: Aetna Medicare Advantage	$19,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,715.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,715.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,715.25
Rate for Payer: Cigna Commercial	$32,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,863.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,421.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,832.50
Rate for Payer: UnitedHealthcare Community & State	$1,579.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1,737.08

OSS 4CM BONE PIN

Facility

$48,690.00

Service Code	HCPCS C1713
Hospital Charge Code	270691630
Hospital Revenue Code	278
Min. Negotiated Rate	$1,173.43
Max. Negotiated Rate	$24,345.00
Rate for Payer: Aetna Commercial	$18,502.20
Rate for Payer: Aetna Medicare Advantage	$14,607.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,415.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,415.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,738.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,415.95
Rate for Payer: Cigna Commercial	$24,345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,782.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10,711.80
Rate for Payer: Qualcare PPO/HMO/WC	$7,303.50
Rate for Payer: UnitedHealthcare Community & State	$1,173.43
Rate for Payer: Wellpoint Medicaid Managed Care	$1,290.29

OSS 4CM BONE PIN

Facility

$48,690.00

Service Code	HCPCS C1713
Hospital Charge Code	270691630
Hospital Revenue Code	278
Min. Negotiated Rate	$7,303.50
Max. Negotiated Rate	$11,782.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,738.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,782.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10,711.80
Rate for Payer: Qualcare PPO/HMO/WC	$7,303.50

OSS ADAPT FEM DIAPHYSEAL SEG

Facility

$1,915.65

Service Code	HCPCS C1776
Hospital Charge Code	270697109
Hospital Revenue Code	278
Min. Negotiated Rate	$287.35
Max. Negotiated Rate	$463.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$383.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$421.44
Rate for Payer: Qualcare PPO/HMO/WC	$287.35

OSS ADAPT FEM DIAPHYSEAL SEG

Facility

$1,915.65

Service Code	HCPCS C1776
Hospital Charge Code	270697109
Hospital Revenue Code	278
Min. Negotiated Rate	$46.17
Max. Negotiated Rate	$957.83
Rate for Payer: Aetna Commercial	$727.95
Rate for Payer: Aetna Medicare Advantage	$574.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$488.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$488.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$383.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$488.49
Rate for Payer: Cigna Commercial	$957.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$421.44
Rate for Payer: Qualcare PPO/HMO/WC	$287.35
Rate for Payer: UnitedHealthcare Community & State	$46.17
Rate for Payer: Wellpoint Medicaid Managed Care	$50.76

OSS AVL TI 63MM MOD BSPLT

Facility

$28,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684635
Hospital Revenue Code	278
Min. Negotiated Rate	$4,275.00
Max. Negotiated Rate	$6,897.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,897.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,270.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,275.00

OSS AVL TI 63MM MOD BSPLT

Facility

$28,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684635
Hospital Revenue Code	278
Min. Negotiated Rate	$686.85
Max. Negotiated Rate	$14,250.00
Rate for Payer: Aetna Commercial	$10,830.00
Rate for Payer: Aetna Medicare Advantage	$8,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,267.50
Rate for Payer: Cigna Commercial	$14,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,897.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,270.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,275.00
Rate for Payer: UnitedHealthcare Community & State	$686.85
Rate for Payer: Wellpoint Medicaid Managed Care	$755.25

OSS AVL TIB BUSHING SET

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684637
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

Know your out-of-pocket cost for care.

All Charges